Patient refusing Hospice - page 3

I have been a home care nurse for the past two years, prior to that I worked in the clinic setting. I am not, nor ever have been a hospice nurse. In my area, we come in and help the patient on a... Read More

  1. Visit  tewdles profile page
    2
    It is hard to guess a timeline based upon the info you have given, but it sounds as if he is clearly declining toward death.
    I would caution you about visiting on your own time.
    Many might consider that activity a boundary violation that puts both you and the patient at risk.
    I do understand the desire to demonstrate that you are not abandoning them, but it seems you have done everything to empower this patient and family...it might be best for you, and for pt outcomes, if you step compassionately away.

    This is not a criticsm, mind you, just a suggestion.
    tnmarie and OldPhatMC like this.
  2. Visit  jammycakesRN profile page
    1
    I'm not really a fan of sticking around per se. But, seriously, if I tell him I won't ever see him again once he chooses hospice...he will NOT choose hospice. I discussed it with my director & she was okay with it. I don't think there will be much time for too many visits.
    tewdles likes this.
  3. Visit  MomBSN profile page
    0
    This situation reminds me of a conversation I had with a patient's wife just yesterday. The patient and his wife refused the Physician's recommendation for Hospice and opted to have home health involved. Medically, this patient is very appropriate for hospice. I did not mention hospice to the wife but she shared with me that she and the patient refused hospice as it was against their moral beliefs. She stated that while she understood hospice's purpose, the choice of giving up of "the good fight" was like choosing to end your life. Now although as a Nursing Professional, I may not share this belief I am also a patient advocate and so I chose to support the patient and his family in the best manner I know how.

    I see that they are willing to have a hospice and hopefully things will work out for the best. It sounds like you have done the right thing by clearing the visits with the director as well.

    In review of the situation, I wonder if you have a MSW to consult regarding end of life/hospice info? Or since you are uncomfortable with end of life, perhaps there are some Nursing continuing ed in your area?
  4. Visit  kat7464 profile page
    0
    You can't do anything. You have explained to them their option for hospice and they refused. They have the right to make decisions that none of us agree with but themselves. Love them, treat the patient as the caring home health nurse you are, and walk away. It's sad, it's nerve-wracking, but people have the right to make choices we don't like. I feel your pain - the exact same thing happened to me and the patient died in the hospital, with no family to support him, tubes everywhere, on Christmas Eve. It could have ended so differently. I left home health (loved it, though) and am now in hospice (love it more). Best of luck to you....don't let this stuff get to you.
  5. Visit  tewdles profile page
    2
    Quote from MomBSN
    This situation reminds me of a conversation I had with a patient's wife just yesterday. The patient and his wife refused the Physician's recommendation for Hospice and opted to have home health involved. Medically, this patient is very appropriate for hospice. I did not mention hospice to the wife but she shared with me that she and the patient refused hospice as it was against their moral beliefs. She stated that while she understood hospice's purpose, the choice of giving up of "the good fight" was like choosing to end your life. Now although as a Nursing Professional, I may not share this belief I am also a patient advocate and so I chose to support the patient and his family in the best manner I know how.

    I see that they are willing to have a hospice and hopefully things will work out for the best. It sounds like you have done the right thing by clearing the visits with the director as well.

    In review of the situation, I wonder if you have a MSW to consult regarding end of life/hospice info? Or since you are uncomfortable with end of life, perhaps there are some Nursing continuing ed in your area?
    I often ask why they believe that choosing hospice is giving up hope or "the good fight". Generally, these people are not given "better" options for care when they have a terminal diagnosis, they often have been told that there is "nothing more we can do for you" in the curative model of care. Sometimes just verbalizing their thoughts, fears, feelings about this topic will help them to discover their goals going forward.
    tnmarie and Ginapixi like this.
  6. Visit  jammycakesRN profile page
    1
    He passed tonight. Maybe he can finally get some rest.
    tewdles likes this.
  7. Visit  Pets to People profile page
    0
    The wife was asking you for information, because she was scared and unsure and had developed a trusting relationship with you, but you just kept blowing her off by trying to send her to someone else to answer her questions because you were not sure what to tell her. You could have talked with your local hospice people and gotten yourself informed, then gone back and given her the information she was asking you for.
  8. Visit  jammycakesRN profile page
    0
    Yeah, that's not even close to being the case. I went to every supervisor I had AND consulted with our sister hospice company. My supervisors told me that we could not provide the "hospice care" he required BECAUSE we have a sister hospice company & they needed to be referred to hospice. I was in no way " blowing her off".
  9. Visit  FLArn profile page
    0
    Is your "sister hospice company" the only hospice provider in your area? and is the reason they are saying hospice care can not be provided is because it would be a conflict of interest in some way since the two companies are owned by the same "parent" company? Are they afraid of breaking some medicare reg or similiar law/reg? I guess I am not understanding the problem?
  10. Visit  anashenwrath profile page
    0
    I'm sorry to hear your patient passed. But I hope that, like you said, he (and his wife) will be able to get some peace now. And I hope you will get some rest too! You put a lot of effort into the situation. As a nursing student, I can't really offer any advice. But it looks like you went above and beyond trying to care for this patient.
  11. Visit  Pets to People profile page
    0
    Quote from jammycakesRN
    Yeah, that's not even close to being the case. I went to every supervisor I had AND consulted with our sister hospice company. My supervisors told me that we could not provide the "hospice care" he required BECAUSE we have a sister hospice company & they needed to be referred to hospice. I was in no way " blowing her off".
    A person can be referred to hospice by anyone...a neighbor, you, their physician, it doesn't matter, so long as they are referred. So that solves that problem....next, proper education delivered to your patient and his wife. There is so much rampant misunderstanding of hospice, and this includes patients, nurses and doctors, that it is really sad, especially when the information you need to find in order to educate yourself is right at your fingertips, aka google or telephoning your local hospice.

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